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PA abdomen
| Question | Answer |
|---|---|
| Chief complaints | abdominal pain, indigestion, vomiting, diarrhea, constipation, flatus, melena, fecal incontinence, jaundice, dysuria, hematuria, radiating pain, etc |
| PMH | allergies, substances, preventatives, trauma, illness/surgeries, mental health, environmental exposures |
| personal/social history | ADLs, nutrition (increased fat, acid, gas formation, intolerances, cultural/ethnic foods, wt loss or gain), stresses, coping, values/beliefs, relationships, economics |
| family hx | gallbladder disease, kidney disease, malabsorption syndrome, hirschsprung disease, colon cancer |
| hirschsprung disease | part of the colon is missing nerves and cannot contract, so obstruction occurs |
| alimentary tract | 27 foot tube from mouth to anus |
| esophagus | 10 inch collapsible tube, connect pharynx to stomach, in chest and abdominal cavities |
| stomach | in left upper quadrant below diaphragm. 3 sections are fundus, body, and pylorus. Secrete HCl/enzymes to break down fats/proteins |
| small intestine | connects stomach to large intestine, 3 sections are duodenum, jejunum, and ileum. complete digestion, nutrients absorbed throguh wall into body |
| large intestine (colon) | connects small intestine to anus. 4 sections are cecum, ascending colon, transverse colon, descending colon. Functions include water absorption, lubrication, and putrefication |
| functions of alimentary tract | ingest and digest food, absorb nutrients/electrolytes/water, excretes watses, peristalsis |
| peristalsis | moves food along tract |
| liver (location) | four lobes in right upper quadrant |
| liver (major functions) | metabolizes fats and carbs, converts amino acids to glucose, synthesizes fats from carbs/proteins, stores vitamins and iron, detoxifies harmful substances, produces antibodies/blood coagulants, synthesizes bile, converts waste from fat to water soluble |
| gallbladder | pear shaped organ recessed in liver, concentrate and store bile |
| pancreas | • Located behind/beneath stomach • Function: produces digestive juices and insulin/glucagon |
| spleen | positioned in LUQ below kidney; 2 tissues- white pulp (filters blood, produces wbcs), red pulp (stores/releases blood) |
| kidneys | retroperitoneal, connected to bladder via ureters, rid body of wastes, produces renin, erythropoetin, vitamin D, synthesizes prostaglandins |
| order of abdominal exam | inspect, auscultate, percuss, palpate |
| Four Quadrants of abdomen | right upper quadrant, left upper quadrant, right lower quadrant, left lower quadrant |
| Inspection of abdomen | surface characteristics, contour (flat, round, scaphoid, protuberant), location of umbilicus, symmetry, surface motion (pulsations), distention |
| abdominal aortic aneurysm | bruit, wide aorta, decreased femoral pulses, 50% asymptomatic |
| 9 causes of distention (9 F's) | fat, fluid, feces, fetus, flatus, fibroid, full bladder, false pregnancy, fatal tumor |
| causes of increased bowel sounds | gastroenteritis, early obstruction, hunger |
| borborygmi | loud gurgling |
| high pitched tinkling upon auscultation | early obstruction |
| decreased bowel sounds | late obstruction, peritonitis, paralytic ileus |
| absence of bowel sounds | must listen for 2-5 minutes |
| bruit | sounds like murmur, turbulent flow (use bell) |
| friction rub | check over spleen and liver, high pitched sound associated with respiration (use diaphragm) |
| percussion of liver | percuss at R MCL, go from tympany or resonance to dullness. |
| average span of liver | 6-12 cm |
| when is liver displaced downward? | lung disease |
| when is liver displaced upward? | pregnancy |
| percussion of spleen | o Percuss along left anterior axillary line- should be no dullness o May be area of dullness between 6th and 11th rib just posterior to left midaxillary line (not >7cm) |
| percussion of kidneys | CVA tenderness (kidney punch) |
| light palpation | 1 hand, <1 cm depth |
| deep palpation | 2 hands, dominant hand down |
| palpation of liver | normal liver edge should be soft to moderately firm, smooth, distinct margins, non tender |
| palpation of spleen | not normally felt, enlarges toward midline |
| palpation of kidneys | press both hands together |
| palpation of abdominal aorta | palpate deeply, just above umbilicus, normal aortic pulse may be felt, but should be anterior in direction (lateral pulsation suggests abdominal aortic aneurysm) |
| signs of advanced liver disease | hyperbilirubinemia (icterus, jaundice, bilirubinuria), ascites, increased estrogen levels, lower extremity edema, varices |
| icterus | yellowing of the eyes |
| jaundice | yellowing of the skin |
| bilirubinuria | bilirubin in urine, dark color |
| detection of ascites | percuss for dullness/shifting of dullness |
| signs of increased estrogen levels | gynecomastia, spider angiomata, testicular atrophy |
| rebound tenderness | pain or tenderness upon removing pressure, not placing pressure |
| appendicitis | inflammation/rupture of appendix |
| cholecystitis | inflammation of gallbladder |
| pancreatitis | inflammation of pancreas |
| diverticulitis | inflammation of diverticula |
| volvulus | twisting of intestines |
| salpingitis | inflammation of fallopian tube |
| PID | pelvic inflammatory disease |
| renal calculi | kidney stones |
| peritonitis | inflammation of peritoneum, most commonly due to ruptured appendix |
| misc. causes of abdominal pain | perforated ulcer, intestinal obstruction, ectopic pregnancy, ruptured ovarian cyst, splenic rupture |
Created by:
alexadianna
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